Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 7CQ5-RC1-TX59 | MD |
NPI | 1437817590 |
---|---|
Provider Name | Mrs. Susan L Chang |
First Address | Gaithersburg, MD 20877-1308 |
Second Address | Gaithersburg, MD 20877-1308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2021 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C520778522108 | (05) | MD |
C-520-778-522-108 | (05) | MD |